1170 NE 102 StPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date G *— ( Job Address / / 7 D /2' LC / 0 7. 5T Tax Folio
Legal Description Historically Designated: Yes
Owner/Lessee / Tenant A d$ e r' A A ( l D
Owner's Address // 7 v 4 / 6 / U 5 T
Contracting Co. P2 km 6 C A, 5 f 42' 1 Ct 4 1'L e. Address
Qualifier /%1.i11.11 c if; Q O ( = 0 /t) 0 . 7", ipt. SS# Phone 75 9 — State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL LUMB1I MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION .
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT
RADON
APPROVED:
Zoning
Mechanical Plumbing
Building _ C
Master Permit #
Phone
D -
Notary as to Co
My Commission
Electrical
Square Ft. Estimated Cost (value)' /f D
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I
certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
2—X1
Signature o ontractor or Owner - `.r• ilder Date
7- —5 - 0
Date
C.C.F. NOTARY BOND
TOTAL DUE 4
Engineering
8U LDING
ELECTRICAL
PIING
Owner of
Building
l •
MIAMI SHORES VILLAGE. FLORIDA
PERMIT N° 9028
Wor be performed under this Permit
Architect
Contractor 1
f
or ( Builder �., �-- " -„ p ,- • �
Legal Lc( Bl.
Description ,µ
A es of ` .4' L. Value of Amt. of '"
BI 1ding // ,) is ) / r • . / (- .1 ,....; 1 '` Project $ I Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
for in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
inge, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
ted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
ng to the work covered hereby whether shown on the plans or drawii gs or in t statements or pecifications and that he assumes responsibility for work
e by his agents, servants or employees. 'l Y f
Signed �, . F . • . c r � „ , J "�'..,,�
" INSPECTOR
In consideration of the issuance to me of this permit I agree to pelf m the work covered hereunder in compliance with all tOrdipnces and regulations
thereto and ,in strict conformity w' the plans, drawings, statements or specifications submitted to the proper authorities ofrMiami Shores Village.
a • • • . this per/ r�seu responsi its for all work done by either, myself, my agent, servant or employee.
• - j .
; '60 ACTOR OR BUILD1R
Subdi-
vision
BY
DATE )," / Ct 4- 195_0_
Contractor's
,License No
r;
AUTHORITY
Permit No
•
Application 4s hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description Lot
Size Septic Tank
Feet of Drain Tile
Nature of Water Supply: (City
Amount of Permit $
ss.
ell
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date ___ /I A-4
No.___ __/ 7e Street _!'Y' • )I
No.141 _ ,t_ Street b f
Block L__l___. SubdivisionJ7
Type of Tank____ — Capacity Gals
Dist. Feet of Tank or Drain Field from Well
__Size of Soakage Pit
Street and Number where work is to be performed —No Street
State work to be perf rmed and purpose of building (By Floors)
New Building Remodeling Addition Repairs
( Signed)
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he u . rstands and accepts his oblig ions as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled Gee al Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, e) work to be performed under this permit, as are
licensed by Miami Shores Village. /
STATE OF FLORIDA, t
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Notary Public, State of Florida
Master Plumber.
No. of Stories
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
CONTR. LIST
--/-
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
MI.�
CONTR.
LIST
34
CHECK
Permit No
•
Application 4s hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description Lot
Size Septic Tank
Feet of Drain Tile
Nature of Water Supply: (City
Amount of Permit $
ss.
ell
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date ___ /I A-4
No.___ __/ 7e Street _!'Y' • )I
No.141 _ ,t_ Street b f
Block L__l___. SubdivisionJ7
Type of Tank____ — Capacity Gals
Dist. Feet of Tank or Drain Field from Well
__Size of Soakage Pit
Street and Number where work is to be performed —No Street
State work to be perf rmed and purpose of building (By Floors)
New Building Remodeling Addition Repairs
( Signed)
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he u . rstands and accepts his oblig ions as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled Gee al Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, e) work to be performed under this permit, as are
licensed by Miami Shores Village. /
STATE OF FLORIDA, t
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Notary Public, State of Florida
Master Plumber.
No. of Stories
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
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